My Meniscus

I spend my days running from room to room seeing patients.  My weekends chasing my children.  While trying to sneak in time to exercise and improve my health.  And also time punishing my body with chips and occasional IPAs.

But you never see the change in your joints coming and then it is there.  I took a step.  Felt a shearing force in my knee.  I was not jumping or hurdling but something funny happened.  I continue my day and pretend that I am fine. 

Then the next day walking to a patient room I feel my knee give out.  Luckily my peripheral nerves, cerebellum and my vestibular center are still intact.  I do not fall.  Immediately I feel a click and realize that this joint is now swollen. Fluid pushing posteriorly.  There is no Baker’s cyst but I am sure that I have an effusion.

There is not pain but I realize that my knee has failed me.  I do not have my partner prescribe me Percocet.  I do not stop working.  I push through because that is what we are taught to do.  I ice my knee and use the occasional ibuprofen.  It is now 2 weeks later and I have still not had it examined.  I have been ignoring and hoping it will go away. 

I often am surprised when patients are not able to explain their pain.  I give them descriptive options if they cannot come up with a description on their own – sharp, achy, lancinating, burning, throbbing, crushing, gnawing, tingling, dull and more.  Yet I cannot even describe how my own knee feels.  It is not pain but discomfort.  Yet discomfort is a type of pain.  It feels tight.  I cannot feel tearing along my tibial plateau.  I cannot tell if it is patella vs medial. 

I worry that I have torn my meniscus.  I am a trained physician.  Yet all I can think about is how my body has failed me.  Will it heal on its own?  When do I get an MRI?  Will I ever play basketball again?  Should my weekend runs come to an end?  Was this an acute tear or degenerative?  Could I be that old that I have a degenerative meniscal tear?  I have started some PT and hope everyday that the effusion will have disappear.  But it has not. 

But if a patient came in with this complaint it would be a simple visit.  I could get a history, examine and create a plan in a few minutes.  I would ask the patient if they had any questions, while hoping the answer was no.  But I am the patient.  And it feels so different and yet it is not even a scary medical issue that I am dealing with.

If I feel this way, I cannot imagine how patients feel.  I realize I need patients to ask me more questions because they have them.  They have concerns and fears.  As do I.  Now that I have finished writing about my fears maybe it is time for me to see a doctor. 

The Doc Is In

Silly Rabbits. Trix are for Kids.

Silly Rabbit. Trix are for kids. Growing up this was a cereal commercial.  It reminded us that this highly sugary cereal was meant for children.  Not a cereal for adults or rabbits, but kids.  Now the most common question I am getting is “Hey doc should my kids get a covid vaccine?”  Silly parents.  Vaccines are for kids. 

I think the best way to start the discussion about children getting vaccinated for covid is by realizing that it is normal for parents to be reluctant.  I think having a conversation about their concerns is a good place for us to get started. 

The Pfizer vaccine has now been approved for children aged 12-16 and it does look like the Moderna vaccine will be approved in the near future. 

Did the vaccine come out too quickly?  The answer to this question is both yes and no.  First I want to point out that the pandemic changed everyone’s lives including virologists, researchers and pharmaceutical companies.  Basically all of the scientists ever involved in vaccines stopped what they were doing to work on a vaccine.  The technology behind mRNA has been around for a while. 

What long term outcomes could happen from the vaccine?  Most vaccine issues happen within the first 42 days.  These vaccines do create quite an immune response but that happens right away.  At this point with adults, we have data almost a year out since the vaccine trials started in adults last summer.  We do not have many examples ever in the past of vaccines not causing immediate issues but then leading to long term negative outcomes. 

What did the kids trials show?  I think parents want real information.  So here it is.  They studied around 3,000 children aged 12-15 for over three months.  Of those that got the vaccine zero were infected with covid by the end of the trial.  And 18 in the placebo trial did get infected with covid.  Also those that were vaccinated were found to have strong immunity a month after the second dose. 

Could my child have side effects?  They can absolutely get an immune response.  Vaccines are not benign, but they can be life saving.  Side effects include redness, arm pain and achiness.  The rate of side effects in the children’s studies were the same as what has been found in adults.

But kids do not really get that sick?  This is true.  But there have been 130.000 hospitalizations in those under 18 in the past year.  I have taken care of many children that had covid.  None of them were critically ill.  But they got their parents sick.  They had to quarantine while they recovered.  There are many pockets of outbreaks from adolescents.  There is also a rare chance that children can develop Multisystem Inflammatory Syndrome in Children after getting COVID-19 infection. 

The world now has given almost 2 billion doses of covid vaccines.  Not all to children.  But at this time it is not experimental.  It is not new.  It is saving the world from a pandemic that would have gone on for many years without vaccines. 

I love well checks for children.  I get an update on what foods they like.  How much weight they have gained.  Whether or not they slept through the night.  I hold them and try to remember when my children were still that little.  Then I give them shots.  Lots of vaccines. At 2 months and 4 months and 6 months and 1 year and more.  Because as I said earlier – Silly parents.  Vaccines are for kids.  But on second thought we probably shouldn’t give Trix to kids. 

The Doc is In

Yelp

Sometimes you can hear a “yelp” even before you enter a room.  You can hear them a few rooms away.  It may be kidney stones, a slipped disc or the gout.  This was the yelping I was ready for when I entered medical school.  Bringing a calm presence to the room so that I can evaluate and develop a plan.  Making sure that patients know we will have a plan to help decrease the acute pain that is providing a “yelp.”

But this is not the yelp that physicians now deal with.  Yelp is a public business founded in 2004 that publishes crowd-sourced reviews about businesses.  This has led to many different companies developing websites where patients can go to document both the good and bad about their physician experiences.  You can go to Health Grades or Vitals and basically write whatever you would like about your experience.

Who uses these apps?  Mostly 2 types of people.  Those that are appreciative of the care or super critical.  It seems that some people as a hobby enjoy pointing out everything that went wrong.  I feel worse for restaurants and hotels, but they are not quite as personal.  If you ever are feeling great about yourself take some time and google your name.  Every displeased patient has put to keyboard your deficiencies.  I use this as a time to fight back.

This is my time to push back on the things that are written about myself and others on the internet.  I am absolutely trying to improve as a physician. And I need constructive criticism but the amount of yelping is getting out of control.  Especially if you use this time to comment on physician’s physical appearance.  Yes.  I realize that since the pandemic started that I have not gotten a haircut.  And yes, I realize that I have a ponytail at this time but that does not affect the care given.  Please stop discussing my hair on the internet. 

Pain medicine.  There are debates about chronic pain medicine.  Currently my office has decided to not treat chronic pain with opiates.  There are pain management doctors that we can help with trying to control chronic pain.  Yet the most common complaint being yelped about is that the doctor allowed me to be in pain.  I first always try to acknowledge the experience pain patients are in and come up with a plan to try and overall reduce pain and functioning.  But it is time to stop yelping about doctors not giving the controlled medicines you ask for.

Wait times.  I get to work early.  Every physician is only one patient away from being behind.  Many patients come in with lists and then wonder why their appointment is not happening right on time.  Just an FYI for patients.  I got here early.  All of you are the reason that then I am running late.  I rarely turn away a patient for being late and it is time to stop posting about how long you waited to see me.

The honest truth is that most patients are writing very nice things on the internet.  But human nature makes us focus on the few negative things written.  I really try not to read all of them but I am human.  I have googled myself and my reviews.  I encourage the rest of you to try your best to avoid reading the reviews sent our way.  Also, I wish my mother and my aunt would stop googling my reviews.  My mom loves to tell me she read about how great my bedside manner is on the internet.  Also she asks me what my plan is to stay on time throughout the day.  After reading the internet my aunt and mother had been discussing ideas on how I could better stay on time.  Thanks yelp.  Thanks for nothing. 

The Doc is In

Keep Pushing

Life is hard. Daily Obstacles.

Keep Pushing. Even if it feels impossible.

Grin and bear it. Force through.

Hard work. Practice. Must pursue.

Never give up. Keep fighting.

Believe in yourself. Blood spilling. End is frightening.

Body is broken. Stress holding.

Looking for answers. But bowels are slowing.

Always had grit. Perseverance.

Still failing. Blocked sigmoid. Inteference.

Stressed. Stop guessing. Not abstract.

Not cancer. Not death. Bowels will not relax. Need miralax.

Face sweating. Fists tight. Push hard. Success. Elation.

From demons to depression. Not those. Just constipation.

You finish. Release. Destroy the bowl.

Nothing could stop you. Won the war. Against your own butt hole.

Urine Drug Tests

Testing – Urine Drug Testing

Physicians often say the hardest thing about medical school was getting in.  I am not sure that I agree but the rest of the experiences do not happen if you do not get in.  How do you get into medical school?  A test score is the main answer.  We all had to take the MCAT.  I remember realizing that many of my friends had taken a full prep course for this test while I had been teaching myself from a work book to take a test that would decide whether or not my life’s dream would come true.  I cannot imagine where my life would be if had not done decent on that test. 

Medical school was all about tests.  We had different systems taught in modules ending with a test.  The first 2 years were more about passing tests than learning for me.  It was biochemistry and physiology and I was still trying to process how this information would help me take care of patients.  Third year of medical school things start to come together.  Each rotation was followed with a test but at least these tests were asking clinical information.  We have Step 1 and then Step 2 and Step 3 and then board certification.  The tests keep coming.

But one has finally been canceled.  The Step 2 Clinical Skills exam has been canceled.  This was the test that cost over 1000 dollars.  It was also only held in 4 cities at the time I was in medical school.  This test consisted of medical students interviewing standardized patients.  I think that this cancellation was a step in the right direction.  Medical schools have the patient interaction/experience added into their curriculums.  This test was a money grab for the boards.  The financial and mental stress that adding this test in was too much for medical students.  From the time it was started many knew this test was wasteful.  All we needed was a pandemic to end it.

It is a new year and we have been updating our controlled substance contracts in my office.  Which means I have been testing my patient’s urine.  This is a test that one cannot study for.  Most patients are taking medicine for the right reasons but the UDS does shed some light on the substance abuse issues that patients are not also forthcoming about.  In medical school there is a plan to focus on certain areas if a particular test is failed.  Tutoring and extra study time.  But what to do if a patient fails a urine drug test.

Do I cut the patient off immediately?  Do we taper down?  I many times have asked the patient if they had issues with substance abuse?  But often times patients do not want to admit.  There was a mistake.  My pills got flushed down the toilet, so I had to take something else.  I promise that I did not take that.  One even wanted to do a lie detector test.  I do not argue about the validity.  This is not meant to be punitive.  I am trying to find ways with these failed tests to see in which ways I can help this patient going forward.  But in a way without prescribing controlled medicines.

Tests are had.  Tests are stressful.  We need to find a way if someone does not do well on a test to help them perform better in the future.  I love seeing patients but still hate discussing their urine drug tests.  I am getting ready to take the Family Medicine Boards again.  At this point in my career I would do well in the Step 2 CS but I am glad it is gone.  Due to the opiate epidemic we need to work together to make sure that urine drug tests that are abnormal can lead to ways to help patients.  Everyone needs to find ways to use this to help improve patients lives.  We can figure this answer out together.  If you do not have the answer right now that is ok.  It is not a test.

The Doc Is In

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